Time to first shock in implantable cardioverter defibrillator (ICD) patients with Chagas cardiomyopathy.

UNLABELLED: The time to first ICD shock has been extensively studied in patients with coronary artery disease (CAD). However, there are no published data on ICD shocks in patients with Chagas cardiomyopathy (ChC). The occurrence of the first appropriate ICD shock during the first 6 months of follow-up in 20 patients with ChC (group 1) and 35 CAD patients (group 2) was analyzed retrospectively. All patients had received a third-generation pectoral ICD for ventricular tachycardia or fibrillation (VT/VF). Indications for ICD implantation were refractoriness to drug therapy or noninducibility of VT/VF at EPS in cardiac arrest survivors. RESULTS: The mean age, left ventricular ejection fraction (LVEF), and sex in groups I and II were 57.4 +/- 7 years versus 64 +/- 9 (P < 0.01), 30.9% +/- 10% versus 32.9% +/- 10% (P = NS), and 10 men versus 31 women (P < 0.005), respectively. Six months after ICD implantation, 85% (17/20) group I patients received appropriate ICD shocks versus 51% (18/35) in group 2, a statistically significant difference (P < 0.02, RR: 1.65, OR: 5.35). CONCLUSIONS: The incidence of appropriate ICD shocks within the first 6 months postimplantation was significantly higher in ChC patients than in CAD patients. ChC patients were younger and more often women than CAD patients.

Implantable cardioverter defibrillators in patients with Chagas' disease: are they different from patients with coronary disease?

Chagas' disease is a parasitic affliction, endemic to certain regions of South America, which may lead to a chronic dilated nonischemic cardiomyopathy. Ten Chagasic patients were compared to 18 coronary patients undergoing transvenous ICD implantation for ventricular tachycardia (VT), ventricular fibrillation (VF), or aborted cardiac arrest. Indications for ICD implantation were either drug intolerance or refractoriness, or no inducible tachyarrhythmia at EPS. There were no statistically significant differences between the Chagas and coronary artery disease groups with respect to age (60.2 vs 62.6 yrs), NYHA Class II (50% vs 62%), ejection fraction (31.1% vs 29.7%), and incidence of cardiac arrest (20% vs 33%), respectively. The following ICD implant and long-term follow-up variables were compared between the two groups: pacing threshold (0.94 V vs 0.95 V), defibrillation threshold (19.5 J vs 19.6 J), number of VT episodes (414 vs 435), number of spontaneous VT terminations (86 vs 187), percent efficacy of antitachycardia pacing (93.9% vs 92.1%), and total number of shocks (112 vs 145). These differences were not statistically significant. We conclude that patients with Chagas' disease, compared with coronary artery disease patients, have similar clinical characteristics leading to ICD implantation. Furthermore, no differences were found with respect to ICD and long-term follow-up characteristics between the two groups.

[The long QT syndrome: epilepsy as the form of presentation]. / Síndrome QT prolongado: epilepsia como forma de presentación.

Prolongation of the QT interval, either on a congenital or an acquired basis, is associated with an increased likelihood of malignant ventricular arrhythmias with a high rate of morbimortality. Symptoms are variables, and patients may develop seizures, syncope and sudden death. Herein we report a young woman 17 years old with long QT syndrome, seizures and recurrent attacks of syncope; her initial diagnosis was primary epilepsy. An electrocardiogram performed 3 years after the initials symptoms was able to make the diagnosis long QT syndrome. The specific treatment controlled the malignant ventricular arrhythmias and the symptomatic status of this patient.

[The selection of resident physicians. The evaluation of their cardiology knowledge and of their pregraduate experience]. / Selección de médicos residentes. Evaluación de los conocimientos cardiológicos y de las experiencias del pregrado.

The purpose of this work was to assess the level of cardiological knowledge in a population of recently graduated physicians and to compare the examination results with pregraduation experiences. The results of the residency entrance examinations of 230 physicians from different universities were analyzed (Table 1). The examination consisted of 70 questions (69 by multiple choice and 1 of professional competence). The cardiovascular area was explored through 28 questions including basic and clinical subjects (Fig. 1). A qualitative and quantitative analysis of the examination was made based on difficulty and discrimination levels (Annex 1-2). A danger level was established when the answer involved a potential risk of death for the patient. Thirty percent of applicants passed the exam (60% of correct answers). Informative questions were easier than those of application and interpretation. A greater difficulty was evidenced with respect to questions in the clinical area (Fig. 3). A higher performance was noted in men, graduates from the University of Buenos Aires and those applicants with assistance and teaching experience. A remarkable positive correlation between average marks during the students career and the level of marks obtained in this exam (Fig. 2) was noted. Twenty-six percent of the physicians who failed gave potentially dangerous answers (Fig. 4). The examination results give us the opportunity to obtain information regarding features of university education.

Selección de médicos residentes. Evaluación de los conocimientos cardiológicos y de las experiencias del pregrado. / [The selection of resident physicians. The evaluation of their cardiology knowledge and of their pregraduate experience]

The purpose of this work was to assess the level of cardiological knowledge in a population of recently graduated physicians and to compare the examination results with pregraduation experiences. The results of the residency entrance examinations of 230 physicians from different universities were analyzed (Table 1). The examination consisted of 70 questions (69 by multiple choice and 1 of professional competence). The cardiovascular area was explored through 28 questions including basic and clinical subjects (Fig. 1). A qualitative and quantitative analysis of the examination was made based on difficulty and discrimination levels (Annex 1-2). A danger level was established when the answer involved a potential risk of death for the patient. Thirty percent of applicants passed the exam (60

of correct answers). Informative questions were easier than those of application and interpretation. A greater difficulty was evidenced with respect to questions in the clinical area (Fig. 3). A higher performance was noted in men, graduates from the University of Buenos Aires and those applicants with assistance and teaching experience. A remarkable positive correlation between average marks during the students career and the level of marks obtained in this exam (Fig. 2) was noted. Twenty-six percent of the physicians who failed gave potentially dangerous answers (Fig. 4). The examination results give us the opportunity to obtain information regarding features of university education.

Selección de médicos residentes. Evaluación de los conocimientos cardiológicos y de las experiencias del pregrado. / [The selection of resident physicians. The evaluation of their cardiology knowledge and of their pregraduate experience]

The purpose of this work was to assess the level of cardiological knowledge in a population of recently graduated physicians and to compare the examination results with pregraduation experiences. The results of the residency entrance examinations of 230 physicians from different universities were analyzed (Table 1). The examination consisted of 70 questions (69 by multiple choice and 1 of professional competence). The cardiovascular area was explored through 28 questions including basic and clinical subjects (Fig. 1). A qualitative and quantitative analysis of the examination was made based on difficulty and discrimination levels (Annex 1-2). A danger level was established when the answer involved a potential risk of death for the patient. Thirty percent of applicants passed the exam (60

of correct answers). Informative questions were easier than those of application and interpretation. A greater difficulty was evidenced with respect to questions in the clinical area (Fig. 3). A higher performance was noted in men, graduates from the University of Buenos Aires and those applicants with assistance and teaching experience. A remarkable positive correlation between average marks during the students career and the level of marks obtained in this exam (Fig. 2) was noted. Twenty-six percent of the physicians who failed gave potentially dangerous answers (Fig. 4). The examination results give us the opportunity to obtain information regarding features of university education.

Hemodynamic effects of intravenous flecainide in acute noncomplicated myocardial infarction.

Hemodynamic and ECG effects of intravenous flecainide were assessed in 10 patients with acute myocardial infarction and no symptoms or signs of heart failure. The dose was 2 mg/kg injected over a 15-minute period. R-R interval did not change, but PR interval and QRS increased significantly, 28% (p less than 0.0005) and 20% (p less than 0.05), respectively. Duration of P wave also increased significantly, 15% (p less than 0.02). Pulmonary wedge pressure increased 29% (p less than 0.005) and cardiac index and left ventricular stroke work index decreased 9% (p less than 0.05) and 20% (p less than 0.05), respectively. No significant change in mean aortic pressure and systemic vascular resistance occurred. Thus, intravenous flecainide has a mild and transient negative inotropic effect in patients with noncomplicated acute myocardial infarction. It did not induce ventricular failure in this group of patients but should be administered cautiously to patients with overt heart failure or severe conduction defects.